eMedicine Specialties > Dermatology > Viral Infections

Erythema Infectiosum (Fifth Disease): Follow-up

Author: Glenn L Zellman, MD, Consulting Staff, Department of Internal Medicine, University Hospital, Tamarac, Florida
Contributor Information and Disclosures

Updated: Dec 8, 2009

Follow-up

Deterrence/Prevention

Because children with erythema infectiosum (fifth disease) are contagious prior to the onset of the classic-appearing rash, preventing the spread of this common childhood exanthem is difficult. Attentive parents can only give their children the general good advice to frequently wash their hands and to avoid the sneezes, coughs, and discarded tissues of children who appear sick.

Complications

Complications of parvovirus B-19 (PV-B19) infection include the following:

  • Aplastic crisis: The parvovirus infects erythroid cells, causing a reticulocytopenia that lasts 7-10 days. A healthy host experiences no consequences, since the normal lifespan of a red blood cell is 120 days. In patients with a background of shortened red blood cell survival, such as hemolytic anemia, an acute aplastic crisis ensues. At-risk conditions in patients include the following:
    • Sickle cell anemia
    • Hereditary spherocytosis
    • Thalassemia
    • Glucose-6-phosphate dehydrogenase deficiency
    • Pyruvate kinase deficiency
    • Autoimmune hemolytic anemia
  • Chronic bone marrow failure: In patients who are immunocompromised and have little defense against PV-B19, a prolonged viremia may occur, affecting all cell lines of the bone marrow. Immunodeficient states include the following:
    • HIV infection
    • Congenital immunodeficiency syndromes
    • Acute lymphocytic leukemia13
    • Immunosuppressive or cytotoxic therapy
  • Congenital infection: PV-B19 can cross the placenta during pregnancy and have a direct cytotoxic effect on fetal red blood cells. Infection may lead to the following:
    • Severe anemia
    • Congestive heart failure
    • Hydrops fetalis (PV-B19 responsible for 10-15% of cases)
    • Intrauterine death (miscarriage or stillborn) in 3-10% of mothers who are infected
  • Papular-purpuric gloves and socks syndrome14,15 : This is an acute self-limited exanthem with fine palpable purpura usually located on the hands and feet, with sharp demarcation at the wrists and ankles. The eruption may be accompanied by fever and aphthous ulcers and occurs more commonly in adults. Rarely, this eruption can involve the perioral and chin area in an acropetechial variant.16
  • Other potential illnesses that occasionally may be linked to or triggered by PV-B19 include the following:
    • Viral-associated hemocytophagia
    • Rheumatoid arthritis/chronic polyarthritis mimicking rheumatoid arthritis17
    • Systemic sclerosis
    • Systemic lupus erythematosus
    • Autoimmune-like pulmonary disease18
    • Idiopathic thrombocytopenic purpura
    • Diamond-Blackfan–like anemia
    • Acute vasculitic syndromes
    • Atypical and nonspecific erythematous exanthem
    • Myocarditis/pancarditis19
    • Hepatitis
    • Uveitis
    • Seizures, encephalitis, and other neurologic manifestations20,21
    • Glomerulonephritis/nephrotic syndrome

Prognosis

The prognosis is excellent for typical childhood cases.

Patient Education

For excellent patient education resources, visit eMedicine's Children's Health Center. Also, see eMedicine's patient education articles Fifth Disease and Skin Rashes in Children.

Miscellaneous

Medicolegal Pitfalls

  • Usually, erythema infectiosum (fifth disease) is a self-limited childhood exanthem that resolves without complications in the classic cutaneous form; however, PV-B19 infections in adults who are pregnant, immunocompromised, or have a chronic hemoglobinopathy can lead to a significant increase in morbidity. Therefore, discussing these negative consequences with parents of the children with the exanthem is important. Parents should warn potentially at-risk people who may have been exposed to the virus and the serious sequelae of infection.

Special Concerns

  • Public health and infection control
    • Since children with erythema infectiosum are contagious only during the asymptomatic viremic period (occurring approximately 1 wk before rash appears), restricting them from attending school is not necessary by the time the clinical diagnosis is made.22
    • Patients with PV-B19–induced aplastic crisis or chronic anemia may be actively viremic during the illness. Patients require routine respiratory isolation, since the virus can be spread via aerosolized respiratory droplets.
    • Potential risk of infection through PV-19 – contaminated blood products and subsequent consideration to screening blood destined for high risk patients.
 


More on Erythema Infectiosum (Fifth Disease)

Overview: Erythema Infectiosum (Fifth Disease)
Differential Diagnoses & Workup: Erythema Infectiosum (Fifth Disease)
Treatment & Medication: Erythema Infectiosum (Fifth Disease)
Follow-up: Erythema Infectiosum (Fifth Disease)
Multimedia: Erythema Infectiosum (Fifth Disease)
References
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References

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Further Reading

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Keywords

erythema infectiosum, fifth disease, slapped-cheek disease, academy rash, Sticker's disease, Sticker disease, childhood exanthem, Parvovirus B19, PV-B19, PV-B19 infection, Parvoviridae family, acute arthropathy, acute polyarthropathy, coryza, pharyngitis, arthralgias, malar rash

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Contributor Information and Disclosures

Author

Glenn L Zellman, MD, Consulting Staff, Department of Internal Medicine, University Hospital, Tamarac, Florida
Disclosure: Nothing to disclose.

Medical Editor

Bernice R Krafchik, MBChB, FRCPC, Professor Emeritus, Department of Pediatrics, Section of Dermatology, University of Toronto
Bernice R Krafchik, MBChB, FRCPC is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, Canadian Medical Association, College of Physicians and Surgeons of Ontario, Royal College of Physicians and Surgeons of Canada, and Society for Pediatric Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Van Perry, MD, Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas Health Science Center
Van Perry, MD is a member of the following medical societies: American Academy of Dermatology and American Society for Laser Medicine and Surgery
Disclosure: Nothing to disclose.

CME Editor

Catherine M Quirk, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania
Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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